Angina

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What is angina?

The heart is the pump responsible for circulating blood throughout the body. Myocardium (myo=muscle + cardium=muscle) is the heart muscle that contracts to pump that blood and like any other muscle, it requires oxygen rich blood for energy. Angina pectoris describes the pain, discomfort, or other symptoms that occur when blood flow to heart muscle cells is not enough to meet its energy needs.

The classic description of angina is a crushing pain that radiates across the chest, sometimes down the arm, into the neck, jaw or teeth, or into the back. It may be associated with shortness of breath, nausea, vomiting, sweating, and weakness.

Many patients do not use pain as a description for angina, instead describing the sensation as a fullness, tightness, burning, squeezing, or ache. The discomfort may be felt in the upper abdomen, between the shoulders, or in the back. The pain may be felt just in an arm, right, left or both, and may or may not be associated with other symptoms.

Angina is often brought on by exercise and activity and gets better with rest. When the body requires the heart to pump more blood, the heart muscle is asked to do more work and that can cause it to outstrip its energy supply. When the body rests, angina should start to subside.

Angina tends to progress slowly over time and patients may not recognize that their symptoms are due to heart disease. It may be fatigue and exercise intolerance, the gradually inability to perform work or other activities that had once been easier to do. It may be shortness of breath with activity like walking up steps or uphill. It is worrisome when the pain comes on at rest or at sleep, since it means that little activity is causing enough stress to cause angina symptoms.

This is the same situation that occurs when muscles in the leg or arm fatigue because of overuse and they begin to ache. The difference is that one can stop lifting or running but the heart cannot stop beating to rest. The other difference is that the symptoms of angina are felt in different ways by different patients and may not be recognized as coming from the heart.

Unfortunately for some patients, they may have no symptoms at all, even with significant narrowing of their coronary arteries, and they may first present for care in the midst of a myocardial infarction or heart attack. This is especially true for women who may have atypical angina symptoms including fatigue, malaise, weakness, and dizziness.

Angina is a warning sign that the heart muscle is not getting adequate blood supply and oxygen. If unheeded it may lead to a heart attack or myocardial infarction (myo=muscle + cardium=heart + infarct=death).

Angina: Don't Take It Lightly

Television shows often introduce certain diseases to ramp up the intensity of the plot line and aside from trauma, heart attacks are perhaps the best way to capture the viewers' attention. There is nothing more dramatic than a character clutching their chest while crumpling to the ground. This gets media ratings but in the real world, a heart attack may be considered a failure of preventive medicine.

Heart disease remains the number one killer in the United States, and each case is a potential failure because risk management wasn't aggressive enough. There are five major risk factors for heart disease:

smoking,

high blood
pressure,

high cholesterol,

diabetes, and

family history.

A person can't do anything about the genes he or she inherited, but the other four risks need lifelong vigilance to avoid not only heart attack but also stroke and peripheral vascular disease. All risk factors involve narrowing of the arteries that supply blood to the body and the consequences that occur when organs don't get enough blood and start to fail.

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